Objective To analyze the complications of total proctocolectomy with ileal pouch-anal anastomosis (TPC-IPAA) in treatment of severe or refractory ulcerative colitis (UC).Methods The retrospective cross-sectional study was conducted.The clinical data of 67 patients with severe or refractory UC who underwent TPC-IPAA in the Xinhua Hospital Affiliated to Shanghai Jiaotong University from February 2008 to October 2015 were collected.All the patients received open and laparoscopy-assisted TPC-IPAA,and two-stage or three-stage surgery was performed according to the patients' conditions.Observation indicators:(1) treatment and follow-up situations,(2) short-term complications after TPC-IPAA,(3) long-term complications after TPC-IPAA.The follow-up using telephone interview and outpatient examination was performed to detect the quality of postoperative life in patients and occurrence of complications up to July 2016.Measurement data with skewed distribution were described as M (range).The comparison of quality of pre-and post-operative life in patients was done using the paired t test.Results (1) Treatment and follow-up situations:all the 67 patients received successful surgery,including 45 with two-stage surgery and 22 with three-stage surgery.Thirty-seven patients underwent open surgery and 30 underwent laparoscopic surgery.The average frequency of postoperative daily defecation,average scores of quality of pre-and post-operative lifes were 5.6,0.47 and 0.67,respectively,with a statistically significant difference between preoperative indicators and postoperative indicators (t =-4.80,P ＜ 0.05).All the 67 patients were followed up for a median time of 4.6 years (range,1.0-8.4 years).(2) Short-term complications after TPC-IPAA:Of 67 patients,10 had short-term complications (some patients with multiple complications).One patient was complicated with presacral abscess secondary to sinus formation and then was cured by topical incision of sinus under colonoscopy.Five patients were complicated with anastomotic site-related complications of TPCIPAA,and 1 with pouch-anal anastomotic fistula combined with presacral abscess underwent drainage with ileostomy and didn't undergo stoma reversion of ileum.Two patients with fistula at the top of pouch were improved by surgery and repair.Of 2 patients with pouch-vagina fistula,1 underwent resection of pouch stump-vagina fistula and then were cured,and the space between pouch stump and posterior fornix was filled with a free greater omentum flap and temporary ileal bypass was simultaneously conducted.The other patient received twice transanal vaginal fistula repairs with advancement flap,and unclosed fistula was confirmed by angiography,with a clinical symptomatic relief.Eight patients with wound infection received actively dressing change after discharge,and no wound dehiscence was occurred.(3) Long-term complications after TPC-IPAA:28 of 67 patients had long-term complications.Twelve patients with intestinal obstruction underwent conservative treatments of gastrointestinal decompression,anti-inflammatory with corticosteroid and anti-infection with antibiotic,without the occurrence of severe intestinal perforation and prognosis needing surgical intervention,including 9 undergoing open TPC-IPAA and 3 undergoing laparoscopic TPC-IPAA.Thirteen patients with postoperative pouchitis received the conservative treatment of mesalazine.Three patients with failed pouch underwent small intestine permanent colostomy,including 2 with secondary pouch Crohn's disease and 1 with severe pouchitis.Conclusions TPC-IPAA is safe and effective in treatment of UC,with a lower incidence of complications.Anastomotic site-related complication of TPC-IPAA is the main short-term complication.And in the long-term complications,pouchitis is the most,followed it is intestine obstruction.

OBJECTIVE To evaluate the bone remodeling in rabbits sinusitis model by CT scan and observing the CT manifestations and time sequence related tendency.METHODS Forty white rabbits(New Zealand) were divided into 5 groups and each group had 8 rabbits.After the sinusitis models were made by incomplete ostia-obstructed and inoculated staphylococcus,we choose one group to be detected by CT scan separately at each time point(2,4,6,8 and 12 weeks after operation).The items we are going to evaluate conclude bone destroy,bone proliferation and sclerosis,soft tissue change,homonymy nasal cavity,opposite side and subcutaneous soft tissue change.The main items were bone destroy,bone proliferation and sclerosis.RESULTS The changes in soft tissue,homonymy nasal cavity,opposite side and subcutaneous soft tissue appear in each group.The main bone manifestation of the change in 2weeks and 4weeks group is bone destroy,no evident bone proliferation and sclerosis.Bone destroy,bone proliferation and sclerosis coexist in the 6 weeks,8 weeks and 12 weeks group.The number of bone destroy and bone proliferation in 6weeks,8 weeks and 12 weeks group is 7,7,6 and 3,5,7 separately.There weren't significant difference about other items among the groups.CONCLUSION The CT manifestations of bone remodeling feature in rabbits sinusitis model include bone destroy,bone proliferation and sclerosis.In the early phase,the main manifestation is bone destroy.While in the late phase(no less than 6 weeks),bone destroy and bone proliferation coexist and the bone proliferation become more obvious over time.

Insolinoma is a rare disease,but with an increased incidence in recent years.From March 2003 to October 2010,16 patients with insulinoma had been admitted to the Nanfang Hospital,and the results of imaging investigation were compared with histopathological examination after operation.All cases had typical Whipple's triad,low plasma glucose and high plasma insulin concentrations. Sixteen tumors were found in total.The detection rate of ultrasonography was 44％ (7/16),and the detection rate of enhanced computed tomography (CT)and magnetic resonance imaging (MRI) were 67％ (8/16) and 75％ (6/8) respectively.The detection rate reached 88％ by combination of CT and MRI.Two patients had no abnormal findings in ultrasonography,CT and MRI,while positive results were found in the arterial stimulation procedure with venous sampiing (ASVS) in both patients.CT or MRI is the preferred approach for localization diagnosis of insulinoma. The ASVS achieves a distinct advantage in localization of insulinoma.

Objective:To investigate the safety and effect of complete mesocolie excision (CME) combined with arterial infusion chemotherapy (AIC) and intra-peritoneal interstitial sustained-release chemotherapy (IPISRC). Methods:A total of 104 patients were classified under the experimental group and underwent CME combined with AIC and IPISRC. The other 98 patients were classified un-der the control group and only received radical surgery. Pre-and post-operative blood routine examinations, as well as liver and kidney function tests, were conducted for both groups. Post-operative adverse reactions and incidence of complications were recorded. Cancer and para-neoplastic tissues were sampled in experimental group. The post-surgery 5-fluorouracil (5-FU) concentration in the drainage fluid as well as those in the peripheral blood , were determined. Three-year follow-ups were conducted, during which the local recur-rence rate, liver metastasis, progression-free survival rate, and total survival rate were recorded. Results: No significant differences were found in the white blood cell count, hemoglobin count, liver and renal functions of the patients before and after the surgery, and rate of adverse reaction and complications between the two groups after surgery (P>0.05). In experimental group , the 5-FU concentra-tion was significantly higher in the cancer tissues than in the para-neoplastic tissues . The 5-FU concentration in experimental group was also significantly higher in the intra-peritoneal drainage liquid and reached its peak in the peripheral blood on day 3 post-surgery . Local recurrence and liver metastasis rates were significantly lower in experimental group than those in control group, whereas the pro-gression-free and three-year overall survival rates were significantly higher in experimental group than in control group (P<0.05). Con-clusion:The tharepy of pations of experimental goup is safe and effective. This method significantly improves the progression-free and three-year survival rates of the patients as well as significantly reduces the local recurrence and liver metastasis rates of colon cancer.

OBJECTIVETo analyze the long-term therapeutic effects of transcatheter arterial chemoembolization (TACE) before liver transplantation.

METHODSForty-six patients with hepatocellular carcinoma (HCC) undergoing liver transplantation in our department between November, 2009 and November, 2011 were analyzed. Of these patients, 24 received TACE before the surgery while the other 22 did not. We compared the liver graft function (ALT and AST levels), immune function (CD3, CD4, CD8, CD4/CD8, NK cells, activated T cells), cumulative survival rate and disease-free survival rate between the two groups at 1 year and 2 years after the operation.

RESULTSThe patients receiving preoperative TACE showed significantly better liver functions and immune function than those who did not receive TACE (P<0.01 and 0.05). The cumulative disease-free survival rate in the two groups were 72% and 46% at 1 year, and were 57% and 33% at two years, respectively (P<0.05); the cumulative survival rate in the two groups were 84% and 55% at 1 year, and 63% and 34% at two years, respectively (P<0.05).

CONCLUSIONTACE prior to liver transplantation can significantly improve the postoperative liver function, immune function, disease-free survival and cumulative survival rates in patients with HCC.

Carcinoma, Hepatocellular ; therapy ; Chemoembolization, Therapeutic ; Disease-Free Survival ; Humans ; Liver Neoplasms ; therapy ; Liver Transplantation ; Postoperative Period ; Survival Rate